When it comes to nutrition and wellness counseling, take the taboo out of Number 2.
Interest in the state of our stool begins when we’re born. The first stool, called meconium, consists of amniotic fluid the fetus swallowed in utero and secretions from the gastrointestinal tract. Its passage is an important indicator of how well a newborn’s GI tract is working.
For parents on diaper duty (for infants) and potty patrol (for toddlers), stool talk is frequent with peers and pediatricians alike. Eventually, as children begin to exert more autonomy, closing the bathroom door and flushing the toilet by themselves, bowel movements become more private matters.
By the time we’re adults, discussion of the topic may seem awkward, but stool gazing—regular observation of stool details, including consistency, color, shape and ease of passage—can offer important clues about a person’s digestive health and wellness. So don’t hesitate to have this important talk with your patients and clients.
Begin by explaining that the body has a natural way of eliminating waste, and that the passage and forming of the stool tells us how well the GI tract is functioning. Use your best judgment in choosing between a lighthearted or more clinical approach, watch the patient’s reaction and bridge to more details. You may be surprised at how forthcoming they become after getting used to the subject.
When it comes to regularity, there is no Golden Rule on how many or how often stools should pass. Ideally, one may prefer a daily or every-other-day pattern of bowel movements. More important is stool consistency, shape and movement with full evacuation of the stools. (Or as one of my clients once put it, until there is no bread left in the box.)
A model stool is bulky, soft, easy to pass and has a uniform, torpedo-like shape. Some stools may warrant a call to the doctor. For example, skinny stools can indicate something abnormal in the colon such as polyps or a mass, while “floaters” (especially really smelly ones) can mean fat excretion. Unless you are taking a weight-loss medication that prevents absorption of fats, you should see your doctor. Stools that look like small pellets or pebbles lumped together can be a result of slow transit time, too little fiber (to retain fluid) or a low-carb diet that’s high in proteins and fats.
Drinking more water, adding more fiber to the diet, eating whole grains, raw fruits and vegetables and trying specialty yogurts and drinks with live active cultures may improve stool consistency and passage. The other end of the spectrum is liquid stools, which move rapidly and sometimes with great urgency. Possible causes include rapid transit time through the GI tract with little fluid being absorbed along the way, raising the risk of dehydration, or sudden changes in diet, such as an increase in fiber or raw foods.
Pathogens like bacterial or viral infections also can result in watery stools as the GI tract tries to rid the body of harmful organisms. Medical treatment for infection or rapid transit is recommended, but if too much fiber is the cause, consider advising your client to eat fewer raw foods and chew thoroughly.
In general, browns are the “normal” stool colors. Occasional inconsistency shouldn’t be of great concern, but persistent or radical changes in stool color should be reported to a physician.
• Black Stools
May be a result of taking iron supplements, but there also could be bleeding in the upper intestinal tract (the esophagus) or stomach.
• Green Stools
Can simply result from eating green foods or, again, taking iron supplements. If accompanied by loose stools, bile excreted from the liver may not be breaking down.
• Gray Stools
May be caused by anti-diarrheal medications or a lack of bile excretion from the liver to digest fats. If no anti-diarrheal medications are involved, recommend seeing a doctor.
• Red Stools
Can come from red food coloring (candies or drinks) or naturally red foods (like beets). It can also result from bleeding hemorrhoids or something more serious.
• Yellow Stools
Are normal in breast-fed infants. For child and adult clients, it may be associated with floating stools and excess fat in the stool, which could be a sign of a malabsorption disorder.
Keeping a two- to four-week diary of food and fluid intake, along with a daily record of stool frequency and details, can help identify potential areas for attention and counseling. With illustrations and descriptions of different types of stools, the National Institute of Diabetes and Digestive and Kidney Diseases’ Bristol Stool Form Scale can be a useful resource.
Jo Ann Hattner, MPH, RD, is a consultant for Sprim Advanced Life Sciences Inc. in San Francisco and author with Susan Anderes, MLIS, of Gut Insight (Hattner Nutrition 2009).